Consequences and management of nasal airway obstruction in the dentofacial deformity patient

Abstract

At the time of orthognathic surgery the maxillofacial surgeon has an opportunity to further contribute to a patient's quality of life by simultaneously addressing long-standing breathing and sinus drainage difficulties that may coexist with the jaw deformity. Breathing difficulties may range from isolated symptomatic nasal airway obstruction to obstructive sleep apnea syndrome and should not be overlooked. The impact of the combined occurrence of nasal obstruction and maxillary deformity has been recognized and discussed in the literature. Studies have established the correlation of obstructed nasal breathing with the development and predilection for specific patterns of dentofacial deformities. It is imperative that the evaluation of either obstructed nasal breathing or a presenting dentofacial deformity take into account both aspects. Treatment of maxillary dysplasia with specific emphasis of transverse expansion and correction of other intranasal sites of obstruction including deviated septum and hypertrophied inferior turbinates seeks to simultaneously address chronic difficulties with nasal breathing, sinus drainage and the presenting jaw deformity. A long-standing forced mouth breathing pattern with open mouth posture is known to impact on maxillo-mandibular growth and be a major contributing factor to developmental jaw deformities. When indicated, simultaneous management of the maxillary jaw deformity (Le Fort I osteotomy) and intranasal abnormality (septoplasty, reduction of inferior turbinates, recontouring of nasal apertures) is effective for the symptomatic relief of nasal airway obstruction. The complication rate for the intranasal procedures and Le Fort I osteotomy when completed simultaneously are minimal and not higher than expected when each procedure is carried out as an isolated event.